Department of Pediatrics, University of Washington, Seattle2Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Neurol. 2016 Jul 1;73(7):829-35. doi: 10.1001/jamaneurol.2016.0992.
To our knowledge, no evidence-based guidelines are available for the best medical management of blood pressure, blood glucose levels, and temperature in pediatric patients after arterial ischemic stroke.
To determine the prevalence of abnormal blood pressure, blood glucose levels, and temperature in pediatric patients with acute arterial ischemic stroke and to explore any association between these measures and neurological outcome.
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective review of children aged 29 days to 18 years with their first arterial ischemic stroke between January 2009 and December 2013 at a tertiary academic children's hospital. Ninety-eight children with stroke were identified by an International Classification of Diseases, Ninth Revision, code search and medical record review. Blood pressure, blood glucose, and temperature data were collected for 5 days after the stroke. Hypertension was defined as systolic blood pressure at or above the 95th percentile for age, sex, and height for 2 consecutive recordings and 2 consecutive days. Hypotension was defined as systolic and/or diastolic blood pressure below the fifth percentile for age, sex, and height for 2 consecutive recordings. Hyperglycemia was defined as a blood glucose level of 200 mg/dL or greater. Morbidity and mortality at 3 months were documented. Data analyses were performed from July 1, 2014, to December 31, 2015.
Abnormal blood pressure, blood glucose levels, and fever in the setting of arterial ischemic stroke.
The a priori outcome measure was poor clinical outcome, defined as a Pediatric Stroke Outcome Measure score of 1 or greater, which represents a moderate neurological deficit.
The median (interquartile range) age of the 98 children was 6.0 (0.6-14.3) years, and 58 (59.2%) were male. Hypertension was present in 64 (65.3%), hypotension in 67 (68.4%), hyperglycemia in 17 (18.1%), and fever in 37 (37.8%). The strongest association with poor neurological outcome was an infarct size of 4% or greater of brain volume (odds ratio, 5.6; 95% CI, 2.0-15.4; P = .001). Hyperglycemia was also independently associated with poor neurological outcome (odds ratio, 3.9; 95% CI, 1.2-12.4; P = .02). Hypertension and fever were not significantly associated with infarct size, poor outcome, or death. Hypertension was not documented in 24 of 87 surviving children (27.6%) at 3-month follow-up and was not associated with poor neurological outcome.
Abnormalities of blood pressure, blood glucose levels, and temperature are prevalent in children with arterial ischemic stroke. Infarct volume and hyperglycemia were associated with poor neurological outcome but hypertension and fever were not. Prospective studies that systematically record blood pressure, blood glucose, and temperature data are required to further assess the associations between these potentially modifiable physiological parameters and pediatric stroke outcome.
据我们所知，目前尚无针对儿科患者动脉缺血性卒中后血压、血糖水平和体温最佳医学管理的循证指南。
确定儿科急性动脉缺血性卒中患者血压、血糖和体温异常的发生率，并探讨这些措施与神经功能结局之间的任何关联。
设计、地点和参与者：我们对 2009 年 1 月至 2013 年 12 月期间在一家三级学术儿童医院首次发生动脉缺血性卒中的 29 天至 18 岁儿童进行了回顾性研究。通过国际疾病分类第 9 次修订版代码搜索和病历回顾，确定了 98 例卒中患儿。在卒中后 5 天收集血压、血糖和体温数据。高血压定义为连续两次、连续两天的收缩压等于或高于年龄、性别和身高的第 95 百分位。低血压定义为收缩压和/或舒张压连续两次低于年龄、性别和身高的第 5 百分位。高血糖定义为血糖水平为 200mg/dL 或更高。记录 3 个月时的发病率和死亡率。数据分析于 2014 年 7 月 1 日至 2015 年 12 月 31 日进行。
动脉缺血性卒中时的血压、血糖水平和发热异常。
预先设定的结局指标是不良临床结局，定义为小儿卒中结局测量评分 1 或更高，代表中度神经功能缺损。
98 例患儿的中位（四分位间距）年龄为 6.0（0.6-14.3）岁，58 例（59.2%）为男性。64 例（65.3%）存在高血压，67 例（68.4%）存在低血压，17 例（18.1%）存在高血糖，37 例（37.8%）存在发热。与不良神经结局相关性最强的是脑体积 4%或以上的梗死灶（比值比，5.6；95%置信区间，2.0-15.4；P = .001）。高血糖也与不良神经结局独立相关（比值比，3.9；95%置信区间，1.2-12.4；P = .02）。高血压和发热与梗死灶大小、不良结局或死亡无显著相关性。在 3 个月的随访中，87 例存活儿童中有 24 例（27.6%）未记录高血压，且与不良神经结局无关。
动脉缺血性卒中患儿血压、血糖水平和体温异常较为常见。梗死体积和高血糖与不良神经结局相关，但高血压和发热则不然。需要前瞻性研究系统地记录血压、血糖和体温数据，以进一步评估这些潜在可改变的生理参数与儿科卒中结局之间的关系。
